Transabdominal Amniocentesis Is a Feasible and Safe Procedure in Preterm Prelabor Rupture of Membranes

Abstract

Objectives: To determine the feasibility and the complication rate of amniocentesis in a large cohort of women with preterm prelabor rupture of membranes (PPROM). Methods: A retrospective cohort study was conducted in all women with singleton gestation complicated by PPROM at between 24⁺⁰ and 36⁺⁶ weeks admitted to the Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, Czech Republic between May 2008 and July 2016. Amniocentesis was offered as a part of a routine protocol of PPROM for the detection of microbial invasion of the amniotic cavity and intra-amniotic inflammation. Procedure was performed under ultrasound guidance. A successful procedure was defined as obtaining at least 0.5 mL of amniotic fluid. No more than 2 attempts were performed. Results: In total, 590 women with PPROM were included. Amniocentesis was successful in 96% (567/590). Two amniocentesis attempts were necessary in 9% (55/590) and the transplacental approach was used in 13% (76/590). No association between gestational age at sampling and the amniocentesis failure rate was found (Spearman rho -0.12; p = 0.71). The complication rate was 0.7% (4/590). Two umbilical cord punctures and 2 chorionic plate fetal vessel injuries occurred, without fetal morbidity. Conclusion: Based on our study population, so far the largest published, amniocentesis is a feasible and safe procedure carrying a very low risk of failure or complications in PPROM.

Risk factors for spontaneous preterm delivery

“…53,63,64 To date, amniocentesis is the only method used to identify intraamniotic inflammation in clinical practice; it is an invasive albeit safe procedure with a very low risk of complications. 65 However, many women and physicians are hesitant about amniocentesis, leading to insufficient knowledge of the clinical impact of inflammation. In women with preterm prelabor rupture of membranes, few studies have been published using a point-of-care test to explore the interleukin-6 (IL-6) content of the cervical fluid related to the intra-amniotic conditions.…”

Cervical and Amniotic Fluid Matrix Metalloproteinase-8 and Interleukin-6 Concentrations in Preterm Pregnancies with or without Preterm Premature Rupture of Membranes

“…The IAI diagnosis is based on the detection of inflammatory biomarkers in AF or, in the case of MIAC, on positive bacterial cultures or molecular microbiology methods. Despite its safety [30], amniocentesis remains an invasive procedure requiring special skills [31,32], and efforts have been made to develop noninvasive biomarker sampling techniques in the diagnosis of IAI [33][34][35][36][37].…”

Gastric fluid used to assess changes during the latency period in preterm prelabor rupture of membranes

“…12 Intraamniotic complications are typically diagnosed through the evaluation of an amniotic fluid sample obtained by transabdominal amniocentesis, mainly at the time of admission. 13,14 Nevertheless, these complications, along with HCA, funisitis, and FIRS may develop subclinically during the latency period (the interval between PPROM and delivery), due to secondary infection caused by ascent of bacteria from the vagina, cervix, or the choriodecidual space to the intraamniotic compartment. 8 Thus, these complications may represent a hidden threat for the fetus and newborn, even in pregnancies undergoing invasive sampling of amniotic fluid.…”